A Sama Tata Foundation Blog

A history of FGM in the United States

April 13, 2012

By Abby Selden

As discussed in the previous article on female genital mutilation (FGM) in Indonesia, this practice is not exclusive to Africa. In addition to Indonesia, it is also practiced in Malaysia, Pakistan and India, as well as several Western countries, including the United States. Between 100 and 140 million women and girls have been subjected to FGM worldwide [1]. And according to an analysis of 2000 Census data conducted by the African Women’s Health Center at Brigham and Women’s Hospital, about 228,000 women in the U.S. have undergone FGM [2].

FGM does have a place in the history of the U.S. In the 1950s and earlier, “clitoridectomies” were practiced in the United States and Western Europe to “treat” women for hysteria, insanity, seizures, epilepsy, emaciation, mental disorders, masturbation, falling of the womb, floating womb, nymphomania, melancholia and lesbianism [3] [4]. Both J. Marion Sims, “the father of modern gynecology,” and Sigmund Freud advocated for “female circumcision” [4]. According to Freud, “elimination of clitoral sexuality is a necessary precondition for the development of femininity” [qtd. in 4].

There is a federal law in the United States—passed in 1996—banning FGM, which makes FGM on anyone younger than 18 years of age a felony, punishable by fines or up to five years in prison [1]. In addition, 17 U.S. states have passed laws criminalizing FGM [2] [5]. However, as U.S. Secretary of State Hillary Clinton said this year, “FGM/C became a federal crime in the United States in 1997, but the procedure persists in some communities. Every government has an obligation to protect its citizens from such abuse” [qtd. in 6]. Today, the FGM that occurs in the United States largely occurs among immigrant communities [3].

For example, in 2003, an Ethiopian immigrant, Khalid Adem, was arrested in Georgia on suspicion that he had practiced FGM on his two-year-old daughter. While Adem claimed that this was untrue, medical exams later confirmed that FGM had been performed. According to the attorney for Adem’s wife and child, Zenobia Arnold, there is “an underground network of people in the Atlanta area who perform female circumcisions” [7].

American doctors have been tasked with treating women victims of FGM who have immigrated to the United States [1]. On April 26, 2010, the American Academy of Pediatrics (AAP) issued a controversial statement, that they were revising a statement issued on July 1, 1998, which had said, “The AAP opposes all forms of FGM, counsels its members not to perform such ritual procedures, and encourages the development of community educational programs for immigrant populations” [8]. In the April 26, 2010, statement, the AAP said that American doctors should be able to offer “a ritual nick as a possible compromise to avoid greater harm girls,” and this may “save some girls from undergoing disfiguring and life-threatening procedures in their native countries, and play a role in the eventual eradication of FGC” [9]. While the statement did continue to say that “efforts should be made to use all available educational and counseling resources to dissuade parents from seeking a ritual genital procedure for their daughter,” the AAP came under extreme criticism for condoning any form of FGM [9].

As Lynn Harris explains in a June 2010 Salon article, “The revised policy sent shock waves through the anti-FGM community worldwide—which is committed to eradicating FGM in all its forms, even when ‘medicalized’ in the interest of harm reduction” [10]. According to the founder and director of the Female Genital Mutilation Education and Networking Project, Marianne Sarkis, the AAP revision was “an insult to all the women who have put their lives on the line fighting these practices” [qtd. in 10]. Sarkis also said that many of her allies in countries that practice FGM, who decided not to perform the procedure on their own daughters “felt betrayed by the system that’s meant to protect them” [qtd. in 10].

Quickly following the publication of this statement by the AAP, the World Health Organization, UNFPA, UNICEF and UNIFEM issued a joint statement, recommending that the AAP revise their new statement so that it is “aligned with internationally agreed positions which are the result of in-depth analysis of FGM and of the approach that successfully leads to the abandonment of the practice” [11]. This join statement declared that the new AAP position “could weaken the efforts to eliminate the practice” and that “of particular concern is the suggestion that some forms of FGM are not harmful and can be supported and performed by medical personnel” [11]. Also, the join statement asserted that by saying a “nick” is sometimes appropriate when performed my medical professionals, “the AAP statement opens a loophole that partially legitimizes the practice of FGM and creates an opening for more invasive procedures,” as well as opening the door to the procedure becoming institutionalized in societies and leading to health care providers developing “a professional and financial interest in upholding the practice” [11].

Finally, the WHO/UN joint statement contested the AAP’s claim that medical professionals performing a “nick” could deter families from performing more severe forms of FGM. First, several studies indicate that many girls are subjected to FGM more than once, sometimes because the family of the girl is not satisfied with the results of the first procedure. As well-known anti-FGM activist and author Ayaan Hirsi Ali explains in a May 2010 Daily Beast article, “Even if we were to consider tolerating it in its most limited form, how could we tell that parents who want to ensure that their daughter will be a virgin on her wedding night will not have her (legally) nicked and then a few months later (illegally) infibulated? I applaud the compassion for children that inspires the pediatricians’ proposal, but they need to eliminate this risk for little girls” [12].

Also, words like “nick” and “prick” are open to interpretation and may be much more severe depending on how they are interpreted. The WHO/UN joint statement cites one specific example of a study in Sudan, which showed that about a third of the women that claimed to have undergone “sunna” FGM, which is supposed to be “just a prick,” had actually been subjected to infibulation, the most severe form of FGM [11]. And as Hirsi Ali explains, “There is a more sinister meaning to the word ‘nick’ if you consider the fact that in some cases it means to cut off the peak of the clitoris” [qtd. in 12]. In response to those who compare the “nicking” of the clitoris to male circumcision, Hirsi Ali says, “In the case of the boys, it is the foreskin that is all or partly removed and not a part of the penis head. In the case of the girls, the clitoris is actually mutilated” [qtd. in 12]. And as Taina Bien-Aimé, executive director of Equality Now, explained, “One can’t violate just a little less or discriminate a little less. The AAP’s suggestions are the equivalent of advising doctors to agree to bind three toes instead of a girl’s whole foot, or supporting child marriage at age 13 instead of 8” [qtd.in 10].

As a result of such opposition, the AAP did retract its statement, only about a month after it was issued. Explained Judith S. Palfrey, M.D., President of the AAP, “Our intention is not to endorse any form of female genital cutting or mutilation. We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere else in the world” [qtd. in 10]. As Harris points out in her Salon article, it is important to remember that “The real enemy is FGM, not the AAP” [10]. Said Soraya Mire, a Somali filmmaker and FGM survivor, “I cried and told them how grateful I am. […] Thank you for understanding us survivors and hearing our voices” [qtd. in 2]. Equality Now spokeswoman Lakshmi Anantnarayan also expressed approval of the AAP’s retraction. “We welcome the AAP’s decision to withdraw its 2010 policy statement on FGM,” she said. “This is a crucial step forward in the movement to raise awareness about female genital mutilation” [qtd. in 2].

Other attempts to perform FGM legally in the United States preceded the AAP’s controversial statement. In 1996, a group of Somali women told doctors at a Seattle Hospital that if some form of FGM were not allowed at the hospital, they would either have the procedure performed by a Somali midwife or take their daughters back to Somalia to have the procedure performed there, where the FGM would undoubtedly be much more severe than if performed by a doctor at the Seattle hospital, where it would have been a “nick.” As Leslie Miller, an OB/GYN formerly at this Seattle hospital, pointed out, “Remember, these women were all infibulated, so it was a big step to not do anything for their daughters” [qtd. in 10]. In response to this request, the hospital proposed that they be allowed to give “a small cut to the clitoral hood, with no tissue excised, conducted under local anesthetic on children old enough to give consent.” However, after a “swift and savage” reaction from the community, FGM opponents and Pat Schroeder, a Representative who had spent years working to enact federal bans on FGM, the hospital’s proposal was abandoned.

According to Bien-Aimé of Equality Now, the responsibility for preventing FGM in the U.S. should not fall solely on doctors. “The AAP should call for the local, state and federal authorities to educate, in a culturally sensitive way, the parents of at-risk girls about the harmful effects of FGM and how it is not necessary to secure a girl’s virginity until marriage or guarantee her chastity,” said Bien-Aimé.

Efforts like these on a government level, however, should already be happening, as Harris explains in the June 2010 Salon article. Harris points out that the 1996 federal ban on FGM in the U.S. “called for funding for outreach efforts, but nothing ever happened” [10]. Says Sarkis, “The Department of State has dropped the ball on this issue” [qtd. in 10]. Following the controversy of the AAP’s statement, New York Representative Joe Crowley said he would “continue pressing Congress to fund strong, comprehensive community-based outreach and education efforts to prevent this human rights abuse” [qtd. in 10].

While there is a federal law banning FGM in the United States, along with laws in 17 states, there is still the issue of those in immigrant communities leaving the country to have FGM performed. Florida, Georgia and Nevada do have “vacation provisions” addressing this issue, but the other states do not. In April 2010, U.S. Representatives Crowley and Mary Bono Mack introduced The Girls’ Protection Act(H.R. 5137), which would have addressed this loophole, but it did not pass. This bill was later re-introduced in June 2011, and in November 2011, a similar bill was introduced [13].

Some U.S.-based organizations are making significant strides in helping FGM victims in immigrant communities living in the U.S. – organizations like Clitoraid, “a private non-profit organization whose goal is to sponsor any African woman who wants to have her clitoris rebuilt,” in an effort to empower them sexually and emotionally [13]. Just last month, Clitoraid announced that its head surgeon, Dr. Marci Bowers, is now training other doctors to perform the restorative surgery, which was developed by French surgeon Dr. Pierre Foldes. Clitoraid is also working to open a dedicated clinic in West African country Burkina Faso, where hundreds of FGM victims are on the waiting list to have the procedure performed for free. This clinic has unofficially been called “The Pleasure Hospital” by volunteers [14].

According to Dr. Harold J. Henning, of Fulton, New York, who is completing his training under Dr. Bowers and will soon begin performing the procedure at the Burkina Faso facility, community awareness is extremely important in the fight to reduce incidences of FGM. “Restoring the sexual pleasure that has been taken away from such victims is the beauty of what we’re doing, and I look forward to helping them by doing the corrective surgery,” he said [qtd. in 14].

According to Hirsi Ali, one of the biggest obstacles to eradicating FGM in the United States is the difficulty in detecting it. “We need to work out a way of knowing when a girl has been mutilated,” she explains. “As a legislator in the Netherlands, this was for me the thorniest issue. In the United States, where civil liberties are even more jealously guarded, the thorns are likely to be sharper still” [12].